Davita Wyncote Dialysis

“POC-MANAGE VOLUME STATUS CFR(s): 494.90(a)(1) The plan of care must address, but not be limited to, the following: (1) Dose of dialysis. The interdisciplinary team must provide the necessary care and services to manage the patient’s volume status; This Standard is not met as evidenced by: 49974 Based on review of facility policies/procedure, medical records (MR), hemodialysis (HD) treatment records, and interviews with the facility administrator (FA) and Nurse Manager, the facility failed to follow its policy for monitoring vital signs, reporting and/or documenting abnormal findings during HD, for seven (7) of seven (7) MR reviewed: CR#1, 2, 3, 4, 5, 6 and 7 Findings include: A review of the facility’s policy Pre-Intra-Post Treatment Data Collection, Monitoring and Nursing Assessment (Policy: 1-03-08) on 1/29/25 at approximately 12:00PM stated “Patient data will be obtained and documented by the patient care technician (PCT) or a licensed nurse. Data collection includes ... measurement of BP (blood pressure), Heart or pulse rate;” “The nursing assessment will be performed and documented by a licensed nurse. The assessment includes the following components: review of patient reports, data collection, response to treatment...Pre-Treatment Data Collection/Assessment: any abnormal findings during pre-treatment data collection will be documented and immediately reported to the licensed nurse. If an abnormal finding is reported to the licensed nurse pre-treatment, the nurse will assess the patient prior to the initiation of dialysis ...the licensed nurse will use his/her clinical judgement based on individual patient needs to determine if any clinical interventions are necessary. The physician (or non-physician practitioner if applicable) will be notified of any concerns that may preclude the initiation of dialysis. If there are no abnormal findings or concerns identified during the pretreatment data collection, the treatment may be initiated....Intradialytic Data Collection/Assessment: the licensed nurse will round on those patients without reported abnormal findings and complete the nursing assessment within one (1) hour of dialysis treatment initiation .... Vital signs and treatment monitoring - for non-nocturnal treatments is completed at least every thirty (30) minutes ....Abnormal findings will be reported to the licensed nurse immediately. The licensed nurse will use his/her clinical judgment based on individual patient needs to determine if any clinical interventions are necessary. The licensed nurse notifies the physician (or non physician practitioner if applicable) as needed of changes in patient status...Abnormal Findings - any weight loss from last post weight .... Blood Pressure Pre-Dialysis: Systolic greater than 180 mm Hg or less than 90 mm Hg; Diastolic greater than or equal to 100 mmHg; Blood Pressure -Intradialytic: Systolic greater than 180 mm Hg or less than 90 mm Hg; Diastolic greater than or equal to 100 mmHg; Blood Pressure Post Treatment: Standing systolic BP greater than 140 mmHg or less than 90 mmHg; Standing diastolic BP greater than 90 mmHg or less than 50 mmHg; Sitting BP for patient ’ s that cannot stand: Sitting systolic BP greater than 140 mmHg or less than 90 mmHg; Sitting diastolic BP greater than 90 mmHg or less than 50 mmHg; Heart or Pulse Rate Pre/Intra/Post: Less than 60 beats per minutes or greater than 100 beats per minutes and/or an irregular heart beat.” A review of Medical Records (MR) was conducted on 4/9/25 from approximately 9:00AM-3:00PM and revealed the following: MR #1, Admission Date: 3/18/2025. The hemodialysis flow sheet dated March 25, 2025 documented a heart rate of 46. A hemodialysis flow sheet dated for April 5, 2025, contained documentation of a blood pressure reading of 153/106 at 11:01 A.M., 140/125 at 11:31 A.M., 171/105 at 11:32 as a recheck. Flow sheets did not indicate that the nurse was notified according to policy. MR #2, Admission Date 10/16/2023. The hemodialysis flow sheet dated April 4, 2025 and April 07, 2025 did not contain documentation that a post assessment was completed. A hemodialysis flow sheet dated for 4/2/2025 contained documentation of a low heart rate of 46. Flow sheets did not indicate that the nurse was notified according to policy. MR #3, admission date 6/18/2024. The hemodialysis flow sheet dated March 29, 2025 did not contain documentation that a post assessment was completed. MR #4, Admission Date: 2/8/2022. The hemodialysis flow sheet dated March 25, 2025, contained documentation of a low heart rate reading of 49 at 13:02, 46 at 13:29, 45 at 13:59, 47 at 14:29. The hemodialysis flow sheet dated April 3, 2025 contained documentation of a low heart rate of 46 at 10:02 am. A hemodialysis flow sheet dated March 27, 2025, contained documentation of blood pressure reading of 115/26 at 06:31 am. A hemodialysis flow sheet dated April 1, 2025, contained documentation of blood pressure reading of 89/52 at 11:29, 93/45 at 11:34. No post assessment was completed for this day. A hemodialysis flow sheet dated for 4/3/2025 did not contain documentation that a post assessment was completed. Flow sheets did not indicate that the nurse was notified according to policy. MR #5, Admission Date 7/11/2024. The hemodialysis flow sheet dated 3/25/2025 contained documentation of a blood pressure reading of 148/105 at 12:30 ; 151/107 at 13:00 ; 148/107 at 13:30; 159/108 (nurse notified)at 14:00 155/107 at 14:30, 155/106 at 15:00, 152/111 at 15:30; 154/106 at 15:41. Nurse was only informed once about high diastolic readings and no assessment conducted by nurse. The hemodialysis flow sheet dated 3/26/2025 contained documentation of a blood pressure reading of 150/102 at 11:08; 148/101 at 11:30; 152/106 at 12:00; 149/102 at 12:30; 143/100 at 13:02. The hemodialysis flow sheet dated 3/27/2025 contained documentation of a blood pressure reading of 135/104, HR 103 at 13:11; HR 103 at 13:30; 140/102; HR 108 at 14:00; HR 107 at 14:30; 134/102; HR 112 at 14:39. The hemodialysis flow sheet dated 3/29/2025 contained documentation of increased heart rate reading of 103 at 12:00; 102 at 12:30; 108 at 13:00; 108 at 13:24; 104 (nurse notified because patient c/o “ heart thumping “ )at 13:30; 103 at 14:00; 101 at 14:30; 108 at 15:00; 115 at 15:21. The hemodialysis flow sheet dated 4/5/2025 contained documentation of a blood pressure reading of 133/102 at 13:02; 146/108 at 14:02 ;146/107 at 14:06; 126/103 at 14:33; 132/108 at 14:54. Nurse was only notified about increase heart rate due to patient complaint, otherwise, nurse was not notified. Flow sheets did not indicate that the nurse was notified according to policy. MR #6, Admission Date 6/07/2019. The hemodialysis flow sheet dated 3/31/2025 contained documentation of a blood pressure reading of 196/107 at 10:12; 181/102 at 11:01; 199/106 at 12:01;189/107 at 12:31 - The hemodialysis flow sheet dated 4/2/2025 contained documentation of a blood pressure reading 176/141 at 11:30. The hemodialysis flow sheet dated 4/4/2025 contained documentation of a blood pressure reading of 194/103 at 10:03; 191/109 at 11:01; 191/105 at 13:01; 184/102 at 13:31; 194/102 at 14:01. The hemodialysis flow sheet dated 4/07/2025 contained documentation of a blood pressure reading of 192/108 at 11:01;179/108 at 11:31;198/90 at 12:01; 182/100 at 12:31; 190/103 at 13:01; 204/93 at 14:02. Flow sheets did not indicate that the nurse was notified according to policy. MR #7, Admission Date 8/8/2023. The hemodialysis flow sheet dated 3/25/2025 contained documentation of blood pressure readings of 107/35 at 11:10; 131/47 at 12:02; 117/24 at 13:02. The hemodialysis flow sheet dated 3/29/2025 contained documentation of blood pressure readings of 135/33 at 11:09; 140/31 at 11:32; 98/45 at 12:32; 179/148; HR: 144 at 14:31. The hemodialysis flow sheet dated 4/3/2025 did not contain documentation that a post treatment assessment was completed. The flow sheet included documentation of blood pressure readings of 105/40 at 11:26; 117/39 at 13:00; 115/39 at 13:30; 123/43 at 14:00; 104/35 at 14:30; 103/46 at 15:00. The hemodialysis flow sheet dated 4/5/2025 contained documentation of blood pressure reading of 107/39 at 10:59;131/35 at 11:31;118/40 at 12:44;123/42 at 13:00; 101/38 at 14:00;111/46 at 14:30;83/34 at 14:50 ;109/41 at 14:51. Flow sheets did not indicate that the nurse was notified according to policy. An interview conducted with the Administrator, Regional Operation, Nurse Manager, Clinical Service Specialist and BioMedical Supervisor on April 11, 2025 starting at 11:30 AM confirmed the above findings.”